To determine whether your SI joint is to blame for the lower back, upper buttock, or leg pain you've been experiencing, a trained doctor will consider your health history, symptoms, results from SI joint pain diagnostic exams, and potentially other medical tests.
It is not always easy to diagnose SI joint disorders, but provocative tests and injections are helpful for confirming the SI joint as the pain source. Sometimes your physical findings may indicate a SI joint condition, but chronic changes may also be seen in your lumbar spine. Your doctor may discuss the difficulty of making a correct diagnosis in the presence of multiple problems.
SI Joint Diagnosis: What to Expect from Your SI Joint Exam
Here's the process a doctor trained in SI joint diagnosis will follow:
- Your doctor will consider all the information you provide, including any history of injury, location of your pain, and problems standing or sleeping.
- Your doctor will also perform a physical examination, including provocative tests.
- You may be asked to stand or move in different directions and point to where you feel pain.
- Your doctor may feel for tenderness over your SI joint.
- A properly performed diagnostic SI joint injection with a local anesthetic is also a common method to determine whether the SI joint is a source of pain.
In addition, X-rays, a CT scan, or MRI may or may not be helpful in the diagnosis of SI joint disorders. It is also important to remember that more than one condition (like a disc or hip problem) can co-exist with SI joint problems, and your doctor will need to check for other factors that may be causing your pain.
Provocative Tests for SI Joint Diagnosis
Provocative tests, the most widely used method to identify SI joint pain, are performed while you are lying on your back or side. In five different positions, your doctor will apply pressure to your hips, knees, and other areas to see which positions may cause discomfort or pain. If only one of the positions causes pain, you may need more testing. If three or more of the positions causes pain in your SI joint region, the SI joint is likely to blame.
SI Joint Injections for Diagnosis
A diagnostic SI joint injection is delivered with either X-ray guidance or CT guidance to ensure that the needle is accurately placed within the SI joint. If, following the injection, your pain is decreased by more than 50%, then it is likely that the SI joint is either the source, or a major contributor to your lower back pain. If the level of pain does not change after the injection, it is unlikely that the SI joint is the cause of your lower back pain.
Will My Insurance Company Cover SI Joint Fusion?
Medicare, most Medicaid, and some commercial health plans provide coverage for minimally invasive sacroiliac (SI) joint fusion procedures. Your plan may require a written authorization prior to surgery. If your plan approves the request, an approval letter from your plan will be provided to you and your surgeon.